MEDICARE: NANTICOKE SURGICAL ASSOCIATES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	1989027203	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CE2117	OTHER	DE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	99032	OTHER	DE	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0108680000	OTHER	DE	AMERIHEALTH HMO
5	487744	OTHER	DE	AMERIHEALTH PERSONAL CHOI
6	792499	OTHER	DE	MDIPA

General Provider Information

NPI Number	:	1972649556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANTICOKE SURGICAL ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	543 N SHIPLEY ST
Second Line	:
City	:	SEAFORD
State	:	DE
Zip	:	19973-2339
Country	:	US
Telephone Number	:	302-629-8662
Fax Number	:	302-629-7661

Provider Business Practice Location Address
First Line	:	543 N SHIPLEY ST
Second Line	:
City	:	SEAFORD
State	:	DE
Zip	:	19973-2339
Country	:	US
Telephone Number	:	302-629-8662
Fax Number	:	302-629-7661

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN DANIEL CARES
Credential	:	M.D.
Telephone Number	:	302-629-8662

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	04/20/2008

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Directions to “NANTICOKE SURGICAL ASSOCIATES, P.A. ” Practice Location

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